Which screening strategy using BMD measurements would be most cost effective for hip fracture prevention in elderly women? A decision analysis based on a Markov model

Abstract

The results of this model, under the assumptions described in the paper, suggest that in women aged 70-80 years, screening all women with dual-energy X-ray absorptiometry (DXA) would be more effective than no screening or screening only women with at least one risk factor. Cost-effectiveness studies based on decision-analysis trees maybe useful tools for helping decision makers, and further models based on different assumptions should be performed to improve the level of evidence on cost-effectiveness ratios of the usual screening strategies for osteoporosis.

The relationship of absolute poverty and bone mineral density in postmenopausal Iranian women

“…The results of this model, under the assumptions described in the paper, suggested that in women aged 70-80 years, screening all women with dual-energy X-ray absorptiometry (DXA) would be more effective than no screening or screening only women with at least one risk factor. 6 Income has been shown to affect treatment initiation after the detection of osteoporosis for previously unscreened, postmenopausal women. 36 These issues highlight the fact that bone health among poor women is multidimensional in its symptoms, multivariate in its causes, dynamic in its trajectory, and quite complex in its relation to poverty.…”

“…The incidence rate sharply increases after the age of 70. 6 It has been projected that more than half of the hip fractures in the world in the year 2050 will occur in Asia. 7 It is increasingly recognized that socioeconomic inequalities play an important role in bone health, with significantly higher fracture rates being reported in lower income groups.…”

Cost-Effectiveness of Different Strategies for Selecting and Treating Individuals at Increased Risk of Osteoporosis or Osteopenia: A Systematic Review

“…While two studies were based on hip fractures only [43,45], more than half of the studies included fractures other than hip, vertebral, or wrist fractures, either by defining an own state "other fracture" as recommended by the IOF or by summarizing fractures with similar costs and utilities [56,57]. For example, disutilities associated with pelvis and other femoral fractures resulted in their being grouped with hip fracture, tibia fracture, and fibula fracture.…”

Volumetric DXA (VXA): A new method to extract 3D information from multiple in vivo DXA images

“…Furthermore, DXA is inexpensive, has a very low radiation dose (effective dose of less than 0.01 mSv), and has been shown to be cost-effective for the management of bone disease. (2,3) Nevertheless, as a measure of the structural integrity of bone, DXA has limitations. DXA is a 2D projection measurement of a 3D object, which limits the geometric and structural information that can be derived from a DXA exam and may, in turn, limit its ability to predict fracture risk.…”